INTRODUCTION

America’s investment in medical research has led to astounding scientific advances that have improved the health and extended the lives of millions of people worldwide. The past 60 years have seen the development of vaccines for infectious diseases like polio, measles, and rubella—diseases that were once common in the United States but that are no longer prevalent in North America. And thanks to medical research, deaths from cardiovascular disease and stroke have declined considerably in the last decade.

Unfortunately, medical research and its associated advances have not been evenly spread across all disease categories. For many infectious diseases that disproportionately affect people in developing countries, the pace of medical advance has been slow. Although diseases like malaria, tuberculosis (TB), dengue, and Chagas disease take a heavy toll in low-income countries—and even occur in the United States—there have been few advances in treatments, diagnostics, and vaccines for these diseases over the last few decades. What is more, the research funding that these diseases have received from governments and the pharmaceutical industry has historically been so meager that these diseases are among a group that has been classified as “neglected infectious diseases” by leading global health research agencies.

Many factors have led to this lack of investment. Drug companies have focused their research and development efforts on the diseases that are most prevalent in affluent countries, where the potential profits are much higher. In addition, because neglected infectious diseases do not affect large numbers of people in wealthier nations that have substantial government-sponsored research and development (R&D) capacity, there are no powerful constituency groups demanding government action.

Since 2000, however, heightened public attention and an influx of funding from philanthropies have prompted some increases in government funding of research on neglected infectious diseases, as well as greater industry activity on them. Unfortunately, these funding increases have not been sufficient, and they may now be at risk: The global economic crisis may lead drug companies to retrench. And recent reductions in U.S. government funding for medical research threaten progress in all research areas, but particularly in areas that have been historically underfunded, such as neglected infectious disease research.

Any loss in the momentum that has been slowly building would be tragic, because experience has shown that, when there is investment in research on global diseases, astounding progress can be made. For example, as mentioned above, our investment in research has led to the development of effective vaccines against polio and measles, and now neither disease is endemic in the Americas. Today, worldwide polio eradication is a real possibility. And cases of measles have been reduced significantly: Global vaccination efforts have resulted in a 68 percent decrease in cases since 2000. Global health experts have set a goal of a 90 percent reduction in measles by 2010. Investments in research made this progress against these diseases possible.

The U.S. government is one of the world’s largest sponsors of medical research. This study evaluates the U.S. government’s commitment to research on neglected infectious diseases that have a global impact. In this report, Families USA examines how much money the U.S. government invests in research on neglected infectious diseases, focusing on funding for the four major U.S. agencies that are engaged in this research: the Centers for Disease Control and Prevention (CDC), the Department of Defense (DOD), the National Institutes of Health (NIH), and the U.S. Agency for International Development (USAID). (See “U.S. Agencies’ Roles in Conducting Global Infectious Disease Research” for a quick summary of the work that these agencies do, and see Appendix II on page 41 for a more detailed description of their work pertaining to global health.) We analyzed funding levels for the following eight diseases: African sleeping sickness (African trypanosomiasis), Buruli ulcer,
Chagas disease (American trypanosomiasis), cholera, dengue, leishmaniasis, malaria, and tuberculosis (TB).

All of these diseases are classified by the World Health Organization (WHO) as neglected infectious diseases because of their high prevalence in impoverished and marginalized populations in the developing world and because of the limited funds that are allocated to research on them. (See “A Snapshot of the Diseases That Are Included in This Report” and Appendix III on page 43 for more information on each of the diseases included in this study.)

Although AIDS is one of the most devastating global infectious diseases, because of the level of worldwide funding for HIV/AIDS research, it is no longer classified as a “neglected infectious disease.” Consequently, U.S. spending on HIV/AIDS research is not part of our study on U.S. funding for neglected infectious disease research. It is important to note, however, that in spite of current spending levels, much remains to be done in HIV/AIDS research, and it is essential that we maintain our current efforts. It is essential because of the global magnitude of the epidemic and because of the way that the epidemic affects our ability to fight other diseases, such as TB. See “HIV/AIDS, Neglected Diseases, and the Research Imperative” for a more detailed discussion of HIV/AIDS research and its link to making progress against neglected infectious diseases.

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